Healthcare Provider Details

I. General information

NPI: 1891131371
Provider Name (Legal Business Name): AMY WINEBARGER LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2013
Last Update Date: 02/26/2020
Certification Date: 02/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37450 SCHOOLCRAFT RD STE 170
LIVONIA MI
48150-1081
US

IV. Provider business mailing address

37450 SCHOOLCRAFT RD STE 170
LIVONIA MI
48150-1081
US

V. Phone/Fax

Practice location:
  • Phone: 734-744-0170
  • Fax: 734-744-0171
Mailing address:
  • Phone: 734-744-0170
  • Fax: 734-744-0171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801090039
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberC-01686
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: